Introduction. The heterotopic gastric mucosal patch or inlet patch is the presence of gastric columnar mucosa outside the stomach, most frequently located in the proximal esophagus. Its manifestations vary from esophageal and extraesophageal reflux symptoms to major complications, most of them being asymptomatic. Aim. To determine the prevalence of cervical heterotopic gastric mucosa in our environment and its association with esophageal and extraesophageal reflux symptoms. Material and methods. Prospective cross-sectional and observational study; consecutive patients who came to our institution between December 2018 and October 2019 for diagnostic upper gastrointestinal videoendoscopy were included, following a questionnaire on clinical manifestations. Results. A total of 1,408 patients were included. In 89 (6.3%), a cervical heterotopic gastric mucosal patch was described. The mean age of the patients without this condition was 54.6 and 55.5 in patients with it. The esophageal symptoms of gastroesophageal reflux (heartburn, regurgitation, and chest pain) in patients with cervical heterotopic gastric mucosa was observed in 40 (44.9% / p = 0.473), 12 (13.5% / p = 0.783) and 4 (4.5% / p = 0.199) patients respectively. The presence of extraesophageal symptoms (globus, chronic cough, dysphonia, and throat clearing) in patients with cervical heterotopic gastric mucosa was: 9 (10.1% / p = 0.011); 7 (7.9% / p = 0.155); 4 (4.5% / p = 0.458) and 9 (10.1% / p = 0.036) respectively. Conclusions. A statistically significant association was found between the presence of cervical heterotopic gastric mucosal patch and symptoms of globus (p = 0.011) and throat clearing (p = 0.036). It could be interpreted that this group of patients would benefit from the research and treatment of this condition with the intention of improving their symptoms.

Background and Objectives. Since the onset of the COVID-19 pandemic, concerns have been raised regarding the risk of infection to both healthcare staff and patients during gastrointestinal endoscopy procedures. Given the importance of performing routine endoscopic procedures to an individual’s future health, we sought to estimate the risk of COVID-19 infection for healthcare staff and patients undergoing endoscopic studies at an ambulatory endoscopy center during the pandemic. Material and Methods. This is a prospective(and) analytical cohort study conducted in an ambulatory gastroenterology center located in the Autonomous City of Buenos Aires, Argentina. Patients undergoing different endoscopic procedures were evaluated for COVID-19 between April 14 and August 31, 2020. COVID-19 was also evaluated in all healthcare and associated staff during the same time period. The risk (cumulative incidence) of acquiring COVID-19 in all patients and staff was calculated. Results. Between April 14 and August 31, 2020, procedures were performed in 3,745 patients with a mean age of 51.12 years; 2,102 (56.18%) were male and 1,643 (43.82%) were female. Follow-up was completed in 3,492 patients, 18 of whom tested positive for COVID-19 standing for an incidence of 0.52% (95%CI 0.31 – 0.81%). Six (5.45%) out of 110 staff members were infected with COVID-19 (1 endoscopist, 4 endoscopy assistants and 1 administrative staff member). In this group, the incidence of positive tests for COVID-19 was 5.45% (95%CI: 2.03 – 11.50%). The increased rates of positive cases among our patients and healthcare professionals were respectively 7.9 and 23.6 times lower than in general population. Conclusion. During the study period, the proportion of COVID-19 infections in our ambulatory specialized in gastrointestinal endoscopy was low and much lower than that in the general population for both patients and healthcare professionals. Endoscopic procedures undertaken at this center were low risk, likely due to strict compliance with established pandemic protocols. Future studies should compare the risk of infection in the hospital setting.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the treatment of choice for obesity with gastroesophageal reflux disease (GERD). There are few reports showing objective data based on esophageal function tests (EFTs). The aim of our study was to evaluate the influence of LRYGB on GERD. Methods: Candidates for laparoscopic sleeve gastrectomy (LSG) underwent preoperative esophageal manometry (EM) and 24-hour pH monitoring. Based on the negative influence of LSG on GERD, patients with abnormal pH were offered LRYGB. Those patients repeated EFTs, esophagogastroduodenoscopy, and symptom questionnaire 1 year after surgery. Results: Two hundred fifty LSG candidates underwent preoperative EFTs; 38% were redirected to LRYGB due to abnormal pH and 13 (18%) completed EFTs postoperatively. In ten women, age: 40 ± 7 years, body mass index: 41 ± 1 kg/m2. EM: lower esophageal sphincter (LES) length increased from 2.6 to 2.9 cm (P = not statistically significant [NS]), and LES pressure decreased from 15 to 14.2 mmHg (P = NS). Preoperatively, LES was normotensive in 12 (92%) patients and postoperatively in 11 (85%) (P = NS). DeMeester score decreased from 35.7 to 11 (P < .001). Postoperatively, 9 (69%) patients resolved their GERD, 3 (23%) improved, and 1 (8%) remained the same (P < .001). Symptoms decreased significantly after surgery. Two patients (15%) had Grade A esophagitis. One of them was able to resolve it, while the other 1 remained the same. Conclusions: Our preliminary data showed that after LRYGB, LES pressure remained the same and DeMeester score decreased, while 69% of patients resolved their GERD. Therefore, LRYGB seems to be an excellent option for obesity and GERD.

Introduction. Endoscopic Full-thickness Resection (EFTR) consists of the full-thickness resection of a limited portion of the digestive wall immediately followed by defect closure. This technique has been proposed for the resection of selected lesions not amenable to conventional endoscopic resection. Objective. The aim of this work is to describe the first three cases of colonic EFTR performed in Argentina. Material and methods. Three patients are described, one with a laterally spreading tumor of approximately 35-40 mm (n = 1) and two with an incomplete adenoma resection with a scar and a non-lifting sing (n = 2). After tumor delineation using a marking probe, EFTR was performed using the full thickness resection device (FTRD, Ovesco, Germany). Antibiotic prophylaxis was prescribed, abdominal plain film was performed 5 hours after the procedure and hospital discharge was granted after twenty four hours. Results. The resection of the lesions was macroscopically complete and no signs of perforation or significant bleeding were detected. Histopathological examination confirmed the complete resection of a tubulovillous (n = 2) and a tubular (n = 1) adenoma, all with high-grade dysplasia. No complications were detected during the follow up. Conclusion. It was concluded that the EFTR is an innovative technique that was effective and safe used in this small series of patients as an alternative to surgery.

Introduction. Barrett Esophagus is an acquired condition secondary to gastroesophageal reflux disease, and it´s the main risk factor for Esophageal Adenocarcinoma. Although there is controversy about tissue sampling at endoscopy when segments are lesser than 10 mm, the prevalence of ultrashort Barrett´s esophagus is up to 20%. Objective. To estimate ultrashort Barrett Esophagus prevalence in a poblational cohort of Argentina and to assess the presence of dysplasia. Methods. A cross-sectional study of the endoscopic and pathological reports of ultrashort Barrett suspicion in an outpatient endoscopy center was performed during 2016-2017. 894 patients were enrolled. Results. 52% of the cohort were male, whose mean age was 56 years (± 12 years). Average Body Mass Index was 26 ± 4 kg/m2. Endoscopically, 50% had hiatal hernia and mean length was 2.32 ± 0.59 cm. Virtual chromoendoscopy was applied in 60% of patients. Ultrashort Barrett´s Esophagus prevalence was 25% (IC 95%), 224/894 patients. Median length was 0.74 ± 0.24 cm. Male sex and presence of hiatal hernia showed a statistically significant association with ultrashort BE presence in multivariate analysis. Conclusion. Ultrashort BE was identified in 25% of the patients, being more frequent in male sex and in patients with hiatal hernia; two variables that are independently related to intestinal metaplasia. Dysplasia was not observed.

Diverticulosis is an acquired condition resulting from herniation of the mucosa through the muscular layer of the colon. It is more common in Western industrialized countries and is asymptomatic in most patients. Its genesis is associated with multiple factors such as age, body mass index (BMI), lifestyle and diet.

Adenomas detection by colonoscopy has an impact on colorectal cancer (CRC) and its mortality. Adenoma detection rate (ADR) is one of the most important quality indicators of VCC.

The objectives of postoperative surveillance in patients operated for colorectal cancer (CRC) are to detect relapses in the anastomosis and/or methachronous lesions. In 2016, an update of the 2006 US Multi-Society Task Force recommendations for surveillance after CRC resection was done focusing in the appropriate use and timing of colonoscopy in this setting.

Barrett’s esophagus (BE) is recognized as a premalignant lesion for esophageal adenocarcinoma. BE appears as a consequence of gastroesophageal reflux disease (GERD), which is increased among obese population. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the best treatment option for obesity combined with GERD. However, data on evolution of BE after LRYGB are scarce.

Colorectal cancer (CRC) is the second leading cause of death from cancer and, its natural history, transforms it into one of the most preventable tumors. Its peak incidence is between 65 and 75 years. Current guidelines for CRC screening set as the upper limit age 75 years; however, increased life expectancy raises a concern to evaluate this age limit.

Colorectal cancer (CRC) is the second leading cause of cancer death in western countries. Its early detection improves survival. Colonoscopy is the gold standard for direct colonic examination but its effectiveness depends on the quality of the procedure, operator’s experience and recommended interval. However, even in these ideal scenarios, there are patients in whom a CRC is detected within five years after performing a VCC without cancer detection, so called Post colonoscopy CRC (PCCRC) or interval CRC. In the last decade, many studies focused on its etiological factors, endoscopic and histologic features. Synchronous polyps as potential PCCRC have received less attention.

Barrett's esophagus (BE) is a risk factor for esophageal adenocarcinoma (EAC) which prognosis depends on the stage at diagnosis. Several scientific societies have developed guidelines for BE surveillance for early detection of malignancy. Adherence to these guidelines includes following appropriate technique and intervals (IV). Technical aspects are difficult to apply and most studies focus on this topic's compliance.

Early detection of Colorectal Cancer (CRC) improves survival. Currently, there are several national and international guidelines for adenomas and CRC screening and post polypectomy surveillance. The videocolonoscopy (VCC) is the recommended method for this strategy, but its effectiveness depends on the quality of the procedure and the operator's experience. However, in scenarios with high quality VCCs and trained endoscopists, there are patients who develop interval colorectal cancer (IV CRC). Several etiological factors have been studied and postulated for IV CRC.

The American Society for Gastrointestinal Endoscopy has proposed two policies for handling diminutive rectosigmoid polyps known as "predict, resect and discard" and "predict and leave in". These strategies were proposed as cost-effective supported on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended.

Obesity is one of the most prevalent metabolic disorders in western populations. The failure of long-term medical treatment is usually frustrating for the patient and for the physician. The Roux-en-Y gastric bypass (RYGB) is one of the bariatric procedures that offers better results. The gastrojejunal (GJ) anastomotic stricture is a common complication (4.73 to 27%) that may occur months to years after the surgery. Endoscopic hydrostatic balloon dilation is an effective intervention with a high success rate in symptoms resolution.

Obesity, a new global epidemic, is associated with multiple metabolic diseases and high mortality. The failure of long-term conservative treatment led to the emergence of new therapies. The intragastric balloon (IGB) is an effective, well tolerated and minimally invasive procedure for loosing weight.

Early detection of colorectal cancer (CRC) improves survival. The impact of primary prevention for adenomas has been studied but so far no firm recommendations have been made.

The effectiveness of colonoscopy, recommended method for diagnosis and treatment of colonic disorders, is determined by the quality of the procedure. Several indicators have been selected for its performance, and the appropriate indication for the procedure is a clue to avoid unnecessary studies.

Adenomatous polyps are predictors of cancer and advanced adenomas. Certain characteristics alert endoscopists about features suggestive of malignancy. Early Colorectal Cancer (CRC) limited to the superficial submucosa, is considered a low-risk disease for lymphatic and blood dissemination. In these cases, Endoscopic Mucosal Resection (EMR) can be considered a therapeutic option. 1) To describe a large series of colonic polyps resected by Endocoscopic Mucosal Resection (EMR), 2) To estimate the prevalence of High Grade Dysplasia (HGD) and early carcinoma in this cohort. reports from EMR of colonic polyps were reviewed Colonoscopies were performed at an outpatient' GI clinic, in Buenos Aires city, between 2004 and 2009. EMR consisted on a submucosal saline injection technique, and main outcome measurement was the description of resected lesions. VCCSTAT 2.0. 394 EMR of 25000 colonoscopies were performed in this period. 48% (190/394) were males. Average age was 56 years (min 24 - max 88 years).All patients were white. 1. With regards polyps 'description the most prevalent findings were : by morphology: non - polyploidy lesions were detected in 70% (95% CI 64 - 75); by location: most lesions were in right colon :43% (95% 39-49); by size: most prevalent size was >10 and ≤ 20 mm in 53% [95% CI 46- 57]; by histology: tubular adenoma was the most prevalent lesion, diagnosed in 33% (95% CI 28- 38). 2. The prevalence of HGD and early carcinoma was 19% (95% CI 15-23). Predominant characteristics of these 68 lesions are described in table 1.Table 1Predominant characteristics of lesions with HGD and early adenocarcinomaMost prevalent characteristics of lesionsN lesions%(95% CI)MorphologyPolypoid3857 (44 - 69)LocationRectum2232 (21 - 44)Size>10 and ≤ 20 mm2133 ( 22 - 46)HistologyHGD3957 (44 - 69) Open table in a new tab According to these results, morphology and location cannot be used to infer histology as benign and malignant lesions are different in these features. HGD and early carcinoma can be detected in fifth of these lesions, so efforts should aim to promote and improve this effective and safe technique.